Grievance & Appeals Coordinator I

Immediate need for a talented Grievance & Appeals Coordinator I. This is a 12+ Months Contract opportunity with long-term potential and is located in Woodland Hills CA or Sacramento CA PST(Remote). Please review the job description below and contact me ASAP if you are interested.

Job ID:25-60840

Pay Range: $21 - $22/hour.  Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
 
Key Responsibilities:

• A typical day in the role of a Case Coordinator for Appeals and Grievances involves processing and resolving member appeals and grievances, ensuring each case is handled with accuracy and timeliness.
• The coordinator collaborates closely with the member and team on cases, providing essential support and maintaining clear communication throughout the process.
• The role also involves contributing to continuous improvement initiatives, identifying opportunities to enhance operational efficiency and customer satisfaction.
• Daily tasks require a keen attention to detail, effective problem-solving, and teamwork within a supportive and collaborative environment.
• The coordinator will be required to work Monday through Friday 8am to 5pm with overtime as need and occasional Saturdays/holidays.
• This Case Coordinator role in Appeals and Grievances is uniquely rewarding, offering the opportunity to make a meaningful impact on member experiences while working within a supportive and collaborative team culture.
• Our team is dedicated to continuous improvement, encouraging curiosity, problem-solving, and personal growth.
• The role provides exposure to complex cases, enhancing analytical and communication skills, and offers the chance to work closely with cross-functional teams.
• Joining us means being part of a dynamic environment that values customer care, operational excellence, and professional development, making it an ideal role for those seeking both challenge and growth.
• The role provides exposure to complex cases, enhancing analytical and communication skills, and offers the chance to work closely with cross-functional teams.
• Joining us means being part of a dynamic environment that values customer care, operational excellence, and professional development, making it an ideal role for those seeking both challenge and growth.

Key Requirements and Technology Experience:

• Skills-Grievance & Appeals Coordinator , Case Coordinator.
• High School diploma or GED.
• Microsoft 365, Genesys.
• Required: 2+ years grievance or appeals, claims or related managed care experience
• 2-3 years of experience in a similar role, preferably within appeals and grievances, healthcare administration, or customer service in a regulated environment.
  Experience working with complex cases or compliance-related tasks is highly desirable.
• Knowledge of Healthcare Regulations – Understanding of health plan compliance, regulatory requirements, or experience with Medicare/Medicaid guidelines.
• Conflict Resolution Skills – Ability to handle sensitive cases with professionalism and empathy.
• Project Coordination Experience – Exposure to coordinating cross-functional projects or initiatives in a fast-paced environment.
• Good Letter writing skills
• Performance indicators: Accuracy and Quality Compliance – Consistently meets or exceeds the 97% quality standard with minimal errors.
• Efficiency and Productivity – Completes case reviews and resolutions ahead of deadlines while maintaining high standards.
• Effective Collaboration and Communication – Proactively collaborates with the management team and cross-functional departments, contributing to positive team dynamics and problem-solving.
• Customer Satisfaction and Resolution – Resolves member grievances effectively, contributing to high customer satisfaction ratings.

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
 
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy .

#prof J2W:CB3